Air Force GME snapshot

There are 3,343physician officers in the Air Force Medical Corps (Jan 07) and 1,327 of these officers are in residency or fellowship programs. There are 750 MDs and DOs training in our in-house military residencies and fellowships. Unlike the Army and the Navy, the Air Force trains a substantial number of obligated MD and DO military officers in civilian programs. There are 446 MDs and DOs training in civilian programs training in deferred status (Inactive Reserves), and 131 MDs and DOs training in civilian programs in sponsored status-essentially on active duty but assigned to a civilian institution. Another unique feature of Air Force GME is that with only a single exception, all of our military residencies are integrated or affiliated with civilian universities. Among the many advantages to this structure are civilian faculty stability in the face of increased deployments and turnover of military faculty, exposure to diverse educators and a broad spectrum of clinical teaching sites.

The annual Graduate Medical Education cycle is about to begin again. With the release of the Integrated Forecast Board results- usually in late June, early July, medical students, residents and field applicants will start submitting applications for post-graduate specialty education. Applications are on our web site The 2007 Tri-Service Joint Services Graduate Medical Education Selection Board (JSGMESB) in Washington, DC, 26-30 November will be hosted by the Air Force. There will be 600 program director/consultant attendees from all three services, 53 selection panels, and 2,000 physician applicants. The Air Force Physician Education Branch usually takes500-550 applicants’ packages to the Selection Board every year. Last year there were 102 applicants from the field, 298 fourth year medical students, 20 PGY 1 only interns, and 44 currently deferred residents. The selection rate for these 444 applicants’specialty choices was almost 70% and for the medical students, the selection rate was even higher, close to 75%.

Fourth year medical students applying to the JSGMESB have many questions about the process and what their chances are that they will be able to train in the specialty of their choice, at their preferred location and venue (military or civilian programs). Our office begins fielding phone calls shortly after the IFB results are released, and our web site logs thousands of hits from July through November. In an effort to highlight one of the most common concerns for our HPSP readers I am providing the following e-mail discussion I had recently with a student who was in a quandary over whether to accept an AF HPSP scholarship. The student’s concerns focused on the degree of control that the student would have over their future specialty choice and whether the military forces students into specialties they would not have chosen.

“First of all, let me assure you that the Air Force never forces you to train in a specific specialty. No one is told he or she is going to become a psychiatrist when he or she wanted to be an obstetrician/gynecologist. We encourage every student to pursue their heart’s desire regardless of how competitive or sought after some specialties are compared to others. Our obligated military medical officers seek the same specialty training as their civilian counterparts. The more competitive or popular specialties such as Anesthesiology, Radiology, Emergency Medicine, and the Surgical sub-specialties have a higher non-selection rate than some of the Primary Care specialties- paralleling the outcomes in the civilian match through the National Residency Match Program (NRMP).

Here is how our process works.Every year between May and June, the Air Force conducts a Forecast Board. The Physician Education Office works with the Assignments Office, the Specialty consultants and the command structure of the Air Force to project how many physicians in each specialty will be required in a given "impact year". The 2007 Forecast Board will project requirements, based on graduate medical education (residencies and fellowships) that will begin in 2008. I will use psychiatry as an example since I am a psychiatrist. Psychiatry residency training is 4 years. The “impact year” for psychiatry in this year's Forecast Board is 2012. A medical student graduating in 2008,wanting to train in psychiatry, would enter training in 2008and finish in 2012.At the end of June, a list of 'requirements' for eachspecialty is posted on our web site (see link below my signature block). Medical students who will graduate in 2008 are required to submit an application by early September of their senior year in medical school, stating what specialty they want to apply for.The Physician Education Office coordinates this process and works with every student individually. In Nov-Dec, the military services hold a Joint Service Selection Board and select applicants to train in all the different specialties. This process is similar to the 'civilian match', NRMP, only the military matchis for students who have been sponsored by the military scholarship programs (HPSP).Our results are released in December andwe work with the NRMPso that they know whom we have selected, before their match in March.

Returning to the psychiatry example, let's say the Forecast Board determines that the Air Force will need 20 psychiatrists in 2012 (the number is derived from equations considering how many 'obligated' psychiatrists we will have on active duty in 2012, how many areeligible to complete their service and separate from the military, and how many patients are projected to need psychiatric care--a number that is increasing based on the current war). The Selection Board will select the top 20 students who have applied to become psychiatrists to enter training in 2008. The Air Force (unlike the Army and Navy) allows approximately 150 physicians to begin training in civilian programs in any given year.There are 2 training programs in psychiatry in the Air Force: one in San Antonio and one in Dayton--these two programs can only train a total of 12 future psychiatrists in any given year---so based on this imaginary example, the Air Force will need to allow 8 future psychiatrists to be 'deferred' to train in civilian programs. When a senior medical student applies to the military selection board, he or she ranks where he/she wishes to train--in one of our active duty programs or in a civilian program. Graduating medical students who do train in civilian programs almost always do so in a deferred status. This means that you continue to train as a civilian in the Inactive Reserve. You receive your salary from the civilian institution. Occasionally, a graduating medical student may train in a civilian program in a “sponsored status”. This means that you are training on active duty but in a civilian program. You get the same pay and benefits as if you were in one of our military programs but you don’t wear a uniform. You do, however, incur additional active duty service commitment for civilian sponsored training.

It is possible that a medical student may get 'non-selected' to train in a specialty. For instance, if 30 students apply to startpsychiatry training in 2008,and the Air Force has projected a requirement for 20 psychiatrists in 2012, 10 students won’t get selected. . Instead, these students will be allowed to train in a PGY 1 internship of their choice: Internal Medicine, Transitional Medicine or General Surgery, and reapply for psychiatry the following year. The students who were not selected in 2007, have a greater chance of being selected in 2008 to start training in 2009, because our scoring system awards points for the internship year.

Please feel free to call my office with any questions you may have: 1-800-531-5800, 210-565-2638, DSN 665-2638”

Molly J. Hall, M.D.

Colonel, USAF, MC, FS

Chief, Physician Education Branch